title: Anatomical suitability of the T-branch stent-graft in patients with thoracoabdominal aortic aneurysms treated using custom-made multibranched endografts.
abstract: OBJECTIVE
  To assess the anatomical suitability of the new off-the-shelf multibranched endograft (t-branch) in patients with thoracoabdominal aortic aneurysms (TAAA) previously treated by means of custom-made multibranched endografts.
  
  
  METHODS
  Clinical and radiological data of 43 consecutive patients (34 men; mean age 72 years) with Crawford types I (n=1), II (n=16), III (n=18), or IV (n=8) TAAAs treated with custom-made multibranched endografts between June 2008 and February 2013 were retrospectively reviewed. Primary anatomical suitability of the t-branch device was assessed using 3-dimensional computed tomographic angiograms. Assisted suitability referred to the ability to use adjuvant procedures to eliminate anatomical obstacles that did not hinder the custom-made devices.
  
  
  RESULTS
  Among the study group, 21 (49%) patients were suitable for treatment using the t-branch device. Another 6 (14%) would have been suitable with the assistance of additional maneuvers, such as thoracic endografting with (n=3) or without (n=3) left carotid-subclavian bypass. Sixteen (37%) patients violated the eligibility criteria due to a distance >56 cm between the celiac trunk and the most caudal renal artery (9, 60%), insufficient diameter (<25 mm) at the level of the visceral arteries (5, 33%), upward orientation of a renal artery (3, 20%), inadequate (>40 mm) proximal landing zone (2, 13%), and a distance <67 mm between the most caudal renal artery and aortic bifurcation (1, 7%).
  
  
  CONCLUSIONS
  The t-branch stent-graft system would have been primarily suitable for implantation in half of the patients. With additional maneuvers, the assisted suitability reached 63%. Further optimization and refinement of the device will probably lead to a shift toward off-the-shelf multibranched stent-graft exclusion of TAAAs.
authors.affiliation: Department of Vascular Surgery, St. Franziskus Hospital and University Hospital of Muenster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.forename: Michel
authors.initials: M
authors.lastname: Bosiers
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.forename: Martin
authors.initials: M
authors.lastname: Austermann
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome